Zhao Jing, Weng Weipin, Chen Chunli, Zhang Jie
Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China.
Eur J Clin Microbiol Infect Dis. 2021 Dec;40(12):2515-2523. doi: 10.1007/s10096-021-04293-4. Epub 2021 Jul 14.
Growing evidence suggests that autoimmune diseases (AIDs) are risk factors for cryptococcal meningitis (CM). Therefore, understanding the epidemiological and clinical profile of CM in patients with AIDs is important. This meta-analysis assessed the prevalence, clinical profiles, and clinical outcomes of CM in AIDs. Studies on CM in patients with AIDs were searched for in PubMed, EMBASE, Web of Science, and China National Knowledge Infrastructure, and meta-analyses were performed using the statistical program of R. Nineteen studies with 36,631 patients with AIDs were analyzed. The overall pooled CM prevalence was 0.4% (95% confidence interval [CI], 0.3-0.6%), 90.7% of which occurred in female patients. Thirteen studies with 77 patients with AIDs diagnosed with CM were analyzed, and the mortality rate was 26.7% (95% CI, 9.5-47.2%). Of patients with systemic lupus erythematosus, 30.1% of CM cases were initially misdiagnosed (95% CI, 0-65.6%). The primary symptom of CM with AIDs was headache (99.4%; 95% CI, 92.1-100%), followed by fever (93.7%; 95% CI, 82.8-100%) and vomiting (37.2%; 95% CI, 13.2-61.2%). The prevalence of CM infections among patients with AIDs should not be underestimated despite non-specific clinical presentations as there were fatal outcomes. Our results suggest that more research is needed to understand the relationship between AIDs and CM, and clinical trials are necessary to improve treatment strategies.
越来越多的证据表明，自身免疫性疾病（AIDs）是隐球菌性脑膜炎（CM）的危险因素。因此，了解AIDs患者中CM的流行病学和临床特征很重要。这项荟萃分析评估了AIDs患者中CM的患病率、临床特征和临床结局。在PubMed、EMBASE、科学网和中国知网中检索了关于AIDs患者CM的研究，并使用R统计程序进行荟萃分析。分析了19项研究，共36631例AIDs患者。CM的总体合并患病率为0.4%（95%置信区间[CI]，0.3-0.6%），其中90.7%发生在女性患者中。分析了13项研究，共77例诊断为CM的AIDs患者，死亡率为26.7%（95%CI，9.5-47.2%）。系统性红斑狼疮患者中，30.1%的CM病例最初被误诊（95%CI，0-65.6%）。AIDs合并CM的主要症状是头痛（99.4%；95%CI，92.1-100%），其次是发热（93.7%；95%CI，82.8-100%）和呕吐（37.2%；95%CI，13.2-61.2%）。尽管临床表现不具特异性，但由于存在致命后果，AIDs患者中CM感染的患病率不应被低估。我们的结果表明，需要更多研究来了解AIDs与CM之间的关系，并且需要进行临床试验以改进治疗策略。
